*Delirium* Causes | Symptoms | Diagnosis | Treatment | Prognosis 🌟Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function that may take hours to days. (the person is conscious but acts involuntarily like a comatose) It is characterized by an inability to pay attention, disorientation, an inability to think clearly, and fluctuations in the level of alertness as day goes by (consciousness). 📍Many disorders, medications, recreational drugs, and poisons cause delirium. like depression, cocaine, drug, alcohol, corticosteroids, Doctors base the diagnosis on symptoms and results of a physical examination, and they use blood, urine, and imaging tests to identify the 📍 *cause* . By finding the cause, one may become successful in preventing the future Dilirium outburts. Promptly correcting or treating the condition causing delirium usually cures it. ◾Delirium is an abnormal mental state, not a disease. Although the term has a specific medical definition, it is often used to describe any type of *confusion.* 🔮Although delirium and dementia both affect thinking, they are different.🔮 Delirium affects mainly ✨attention, and dementia affects mainly ✨memory. Delirium begins suddenly and often has a definite beginning point. Dementia typically begins gradually and has no definite beginning point. 🚨Delirium is never normal and often indicates a usually serious, newly developed problem, especially in older people. People who have delirium need immediate medical attention. 😵‍💫 Delirium affects 15 to 50% of hospitalized people. Delirium may occur at any age but is more common among *older* people. Delirium is common among residents of nursing homes. When delirium occurs in younger people, it is usually due to drug use (prescription, over-the-counter, or recreational) or a life-threatening disorder. ◾◾◾◾◾◾◾ What Is Confusion? Confusion means different things to different people, but doctors use the term to describe people who cannot process information normally. 🌟Confused people cannot; 👉Follow a conversation 👉Answer questions appropriately 👉Understand where they are 👉Make critical judgments that affect safety 👉Remember important facts 👉 Control agitation 👉 Focus on single task/talk. 🌟Confusion has many different causes, including the use of certain drugs (prescription, over-the-counter, and recreational) and a wide variety of disorders. Delirium and dementia, though very different disorders, both cause confusion. When a person is confused, doctors try to determine what the cause is, particularly whether it is delirium or dementia. If confusion develops or worsens *suddenly,* the cause may be delirium. In such cases, medical attention is needed immediately because delirium may be caused by a serious disorder. Also, treating the cause, once identified, can often reverse the delirium. If confusion develops slowly, the cause may be dementia. (weeks) Medical attention is needed but not urgently. Treatment may slow the mental decline in people with dementia but usually cannot stop the decline. 🌟Causes of Delirium Development or worsening of many disorders can cause delirium. Any person can become delirious when extremely ill or taking medications or drugs that affect brain function (psychoactive medications or drugs). 🌟Overall, the most common causes of delirium are the following: Drugs or medications (particularly those with anticholinergic effects or psychoactive effects) and opioids Dehydration Infections, such as pneumonia, a bloodstream infection (sepsis), infections that affect the whole body or cause a fever, and urinary tract infections Kidney failure, liver failure, and a low level of oxygen in the blood (hypoxia, as can occur in pneumonia), especially when these disorders begin suddenly and progress rapidly 🌟Other causes include hospitalization, surgery, withdrawal of a drug that has been taken for a long time, certain disorders, and poisons. 👉Delirium often develops during hospitalization in people who have *dementia.* Delirium can result from less severe conditions in older people and in people who have had a stroke or who have dementia, Parkinson disease, or brain damage due to another condition. Less severe conditions that can trigger delirium include Minor illnesses (such as a urinary tract infection) Severe constipation Pain Use of a bladder catheter (a thin tube used to drain urine from the bladder) Dehydration (diuretics/NOP/diarrhea/fasting/surgery) Prolonged sleep deprivation (insomnia) Sensory deprivation (including being socially isolated and not having access to needed eyeglasses or hearing aids) In some people, no cause can be identified. Hospitalization Being in unfamiliar surroundings such as a hospital, particularly in an intensive care unit (ICU), can contribute to or trigger delirium. In ICUs, people are isolated in a room that typically has no windows or clocks. Thus, people are deprived of normal sensory stimulation and can become disoriented. Sleep is disturbed by staff members who awaken people during the night to monitor and treat them and by loud beeping monitors, intercoms, voices in the hallway, and alarms. Furthermore, most people in ICUs have serious disorders and may be treated with medications that can trigger delirium. 💫People in ICUs may have seizures that do not cause convulsions (called nonconvulsive seizures). These seizures can cause delirium, but the seizures may not be recognized because they do not cause convulsions or other typical symptoms of seizures. If the seizures are not recognized, they may not be treated appropriately and promptly. 🌟Surgery Delirium is also very common after surgery, probably because of the stress of surgery, the anesthetics used during surgery, and the pain relievers (analgesics) used after surgery. Delirium may also develop when people who are about to have surgery do not have access to a substance they have been using, such as a recreational drug, alcohol, or tobacco. When people stop using such substances, they may have withdrawal symptoms, including delirium. 🌟Drug use The most common reversible cause of delirium is use of medications and recreational drugs. In younger people, using recreational drugs and acute intoxication with alcohol are common causes. In older people, prescription medications are usually the cause. 🌟Psychoactive drugs directly affect nerve cells in the brain, sometimes causing delirium. They include the following: Opioids (including morphine and meperidine) Sedatives (including benzodiazepines and sleep aids) Antipsychotics Antidepressants Many other drugs can also cause delirium. The following are some examples: Medications with anticholinergic effects, including many over-the-counter (OTC) antihistamines Amphetamines and cocaine, which are stimulants Cimetidine Medications that lower blood pressure (antihypertensive drugs, including beta-blockers) Corticosteroids Digoxin and certain other medications used to treat heart disorders Levodopa Muscle relaxants Drug withdrawal Delirium can also result from suddenly stopping a medication or drug that has been taken for a long time—for example, a sedative (such as a benzodiazepine or barbiturate) or an opioid pain reliever. Delirium commonly occurs in people who have alcohol use disorder and who suddenly stop drinking alcohol (called delirium tremens) and in people who have heroin use disorder and who suddenly stop using heroin. 🌟Disorders Abnormal blood levels of electrolytes, such as calcium, sodium, or magnesium, can interfere with the metabolic activity of nerve cells and lead to delirium. Abnormal electrolyte levels may result from use of a diuretic, dehydration, or disorders such as kidney failure and widespread cancer. Blood sugar levels that are extremely high (hyperglycemia) or low (hypoglycemia) commonly cause delirium. An underactive thyroid gland (hypothyroidism) causes delirium with sluggishness (lethargy). An overactive thyroid gland (hyperthyroidism) causes delirium with hyperactivity. If liver failure or kidney failure develops and is not diagnosed, a medication that a person has been taking for a long time can cause delirium, even though it previously caused no problems. In these disorders, the liver or kidneys do not process and eliminate medications normally. As a result, medications may accumulate in the blood and reach the brain, causing delirium. In younger people (once drugs and alcohol are excluded), the cause of delirium is usually A condition that directly affects the brain—for example, a brain infection, such as meningitis or encephalitis In older people, the cause is often A common infection, such as a urinary tract infection, pneumonia, or influenza Such infections can indirectly affect the brain. Wernicke encephalopathy, which results from by a severe deficiency of the B vitamin thiamin, can cause confusion and delirium. If untreated, Wernicke encephalopathy can cause severe brain damage, coma, or death. Some disorders (such as strokes, brain tumors, or brain abscesses) cause symptoms of delirium by directly damaging the brain. Delirium may be the first symptom in older people with a viral disease, such as COVID-19. 🌟Poisons In younger people, ingestion of poisons, such as rubbing alcohol or antifreeze, is a common cause of delirium. 🌟Spotlight on Aging: Delirium Delirium is more common among older people. It is a common reason that family members of older people seek help from a doctor or at a hospital. About 15 to 50% of older people experience delirium at some time during a hospital stay. Causes In older people, delirium can result from any condition that causes delirium in younger people. But it can also result from less severe conditions, such as the following: Dehydration A disorder that normally does not affect thinking, such as a urinary tract infection, influenza, or deficiency of thiamin or vitamin B12 Pain Retention of urine or severe constipation Sensory deprivation, as may occur when people are socially isolated or are not wearing their glasses or hearing aid An increased sensitivity to medications or drugs 🌟Age-related changes in the brain: Delirium occurs more often in older people partly because some age-related changes in the brain make them more susceptible. For example, older people tend to have fewer brain cells and lower levels of 👉acetylcholine—a substance that enables brain cells to communicate with each other. Any stress (due to a drug, disorder, or situation) that causes the level of acetylcholine to further decrease can make it harder for the brain to function. Thus, in older people, such stresses are particularly likely to cause delirium. 🌟Other conditions: Older people are also more likely to have other conditions that make them more susceptible to delirium, such as the following: Stroke Parkinson disease Other disorders that cause nerve degeneration Use of three or more medications Undernutrition Immobility Older people are more likely to have dementia, which makes delirium harder to identify. Both cause confusion. Doctors try to distinguish the two by determining how quickly the confusion developed and what the person’s previous mental function was. Sometimes both delirium & dementia occurs. 🌟Treatment Delirium and the hospitalization it usually requires can cause many other problems, such as undernutrition, dehydration, and pressure sores. These problems may have serious consequences in older people. Thus, older people can benefit from treatment managed by an interdisciplinary team, which includes a doctor, physical and occupational therapists, nurses, and social workers. 🌟Prevention To help prevent delirium in an older person during a hospital stay, family members can ask hospital staff members to help—by doing the following: Encouraging the person to move around regularly Placing a clock and calendar in the room Minimizing the interruptions and noises during the night Making sure the person eats and drinks enough Family members can visit and talk with the person and thus help keep the person oriented. People with delirium may be frightened, and the familiar voice of a family member can have a calming effect. The hallmark of delirium is An inability to pay attention People with delirium cannot concentrate, so they have trouble processing new information and cannot recall recent events. Thus, they do not understand what is happening around them. They become disoriented. Sudden confusion about time and often about place (where they are) may be an early sign of delirium. If delirium is severe, people may not know who they or other people are. Thinking is confused, and people with delirium ramble, sometimes becoming incoherent. Their level of awareness (consciousness) may fluctuate. That is, people may be overly alert one moment and drowsy and sluggish the next. Other symptoms also often change within minutes and tend to worsen during the evening (a phenomenon called sundowning). People with delirium often sleep restlessly or reverse their sleep-wake cycle, sleeping during the day and staying awake at night.(narcolepsy/disturbed sleep pattern) People may have bizarre, frightening visual hallucinations, seeing things or people that are not there. Some people develop paranoia (unwarranted feelings of being persecuted) or have delusions (false beliefs usually involving a misinterpretation of perceptions or experiences). Personality and mood may change. Some people become so quiet and withdrawn that no one notices that they are delirious, sitting & staying silent & alone. Others become irritable, agitated, and restless and may pace. People who develop delirium after taking sedatives are likely to become very drowsy and withdrawn. Those who have taken amphetamines or who have stopped taking sedatives may become aggressive and hyperactive. Some people alternate between the two types of behavior. Delirium can last hours, days, or even longer, depending on the severity and the cause. If the cause of delirium is not quickly identified and treated, people may become increasingly drowsy and unresponsive, requiring vigorous stimulation to be aroused (a condition called stupor). Stupor may lead to coma or death. 🫡Did You Know... Psychotic behavior that begins during old age usually indicates delirium or dementia. Diagnosis: Mental status testing Blood, urine, and imaging tests to check for possible causes Most people thought to have delirium are hospitalized to evaluate them and protect them from injuring themselves or others. Diagnostic procedures can be done quickly and safely in the hospital, and any disorders detected can be treated quickly. Because delirium may be caused by a serious disorder (which could be rapidly fatal), doctors try to identify the cause as quickly as possible. Treating the cause, once identified, can often reverse the delirium. Medical history Friends, family members, or other observers are asked for information because people with delirium are usually unable to answer. Questions include the following: How the confusion began (suddenly or gradually) How quickly it progressed What the person’s physical and mental health has been like What drugs (including alcohol and recreational drugs, especially if the person is younger) and dietary supplements (including medicinal herbs) the person uses Whether any drugs have been started or stopped recently Information may also come from medical records, the police, emergency medical personnel, or evidence such as pill bottles and certain documents. Documents such as a checkbook, recent letters, or notification of unpaid bills or missed appointments can indicate a change in mental function. If delirium is accompanied by agitation and hallucinations, delusions, or paranoia, it must be distinguished from a psychosis due to a psychiatric disorder, such as manic-depressive illness or schizophrenia. Typically, people with a psychosis due to a psychiatric disorder do not have confusion or memory loss, and the level of consciousness does not change. however; Psychotic behavior that begins during old age usually indicates delirium or dementia. 💫Mental status testing First, they are asked questions to determine whether the main problem is being unable to pay attention. For example, they are read a short list and asked to repeat it. Doctors must determine whether people take in (register) what is read to them. People with delirium cannot. The mental status test also includes other questions and tasks, such as testing short-term and long-term memory, naming objects, writing sentences, and copying shapes. People with delirium may be too confused, agitated, or withdrawn to respond to this test. 🩸Blood Testing; Samples of blood and urine are usually taken and analyzed to check for disorders that doctors think may be causing delirium. For example, abnormalities in electrolyte and blood sugar levels and liver and kidney disorders are common causes of delirium. ⚡⚡⚡⚡⚡⚡⚡⚡⚡